How a radiation oncologist handles the grief of sharing a devastating diagnosis. I met Burt—a healthy-looking 53-year-old with a direct, sky-blue gaze—the Monday before Labor Day. Two years before, he’d had cancer. It was in remission, but for several weeks, he’d been having excruciating low-back pain (a ten out of ten). The day before, a new CT scan showed that his tumor had spread to his liver, bones, and spine—the cause of his pain. If this were my brother, I’d be hysterical. But I’m a radiation oncologist, and this was my patient. I spoke frankly, trying to help the family cope with the nightmare Burt now faced: the near certainty that his life span had abruptly been cut to a matter of months, the reality that most likely no treatment would change the date of his death. “It’s all about comfort, spending time with your family, doing the things you love,” I told him. I outlined a plan for two weeks of radiation to his spine. We started it that same Monday, and Burt improved rapidly. By Thursday, his pain was a zero. Burt, his wife, his son, and I stood in the exam room, giving one another high fives. “There’s one thing,” Burt said. “My right leg feels funny. I think I pulled a muscle getting out of bed.” I couldn’t find any change. “Let’s keep an eye on things,” I said. On Friday, Burt’s family pushed him into my office in a wheelchair; he’d become completely paraplegic. I stood riveted with horror. The likely reason was that, despite the radiation, the tumor was growing. Part of me wanted to fall down and cry, “This is the most awful thing I can imagine—this big, strapping man now has to lift his legs up with his hands!” Another wanted to stamp my feet and weep with frustration and rage at cancer’s cruelty. But I had to do what doctors do: stay clear-eyed, get a history, do an exam, make an assessment, create a plan. I went to my office, sat down, and closed my eyes. Then I picked up my phone and arranged an emergency consult with a neurosurgeon friend. I went back to talk to Burt, who gazed at the wall behind me. “What’s happening here isn’t normal,” I said. “The radiation should have worked. But I think the tumor is still growing, and my only hope is that a surgeon can take some tumor out. I don’t know if he can; I don’t know if he should. I know that we can’t hope this will go away. We have to get you to a neurosurgeon who can operate on Labor Day weekend.” Burt still couldn’t look at me. He sat for a while, then said, “This is my last Labor Day. We were going to our cabin. We were going fishing; we were going to close it up.” One thing the cancer clinic teaches you is that there are times when words are worthless. So I didn’t say anything. Partly I didn’t have any words, and partly I could barely speak. Burt looked down at the floor and closed his eyes. After a long moment, he looked up at me with his sky-blue gaze, gave me a half smile, and said, “Whatever you say, Doc. Whatever you say.” The neurosurgeon was able to book an OR for 9:30 that night. I thought about Burt all evening. When I got up the next morning, an e-mail blinked from my inbox. “Hello,” the neurosurgeon had written at 6 a.m. “He is better after decompression of the L3-4 spinal segments. Better than antigravity.” Translation: The surgery had worked. Burt could move his legs again. Six weeks later, with the help of a cane and a walker, he made it back to his cabin; they fished, they sat on the porch, and then they closed it up. He lived nearly three more months. Source
